Integra or Omnigraft dermal regeneration template

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

MATRIX REGENERATION DURAGEN PLUS 5X7

Payers reporting HCPCS Q4105

Payer pricing summary

Low

Average

$1.8k

Median

$456

High

$11.7k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +26 other terms	265	$125	$242	$613	254%	2–20	$0 – $6.6k
2	UnitedHealthcare fee schedule · outpatient · +23 other terms	478	$146	$477	$2.0k	418%	—	$1 – $30.5k
3	Cigna fee schedule · outpatient · +22 other terms	330	$65	$389	$2.2k	576%	—	$17 – $37.6k
4	Aetna fee schedule · outpatient · +23 other terms	278	$126	$2.0k	$5.0k	245%	—	$20 – $32.7k
5	Humana fee schedule · outpatient · +22 other terms	240	$121	$333	$1.2k	350%	—	$1 – $8.5k
6	Molina fee schedule · outpatient · +20 other terms	96	$149	$1.4k	$3.9k	271%	—	$1 – $27.0k
7	Anthem facility · fee schedule · outpatient · +18 other terms	74	$118	$148	$248	167%	—	$26 – $2.1k
8	Caresource fee schedule · outpatient · +9 other terms	62	$51	$223	$223	100%	—	$1 – $524
9	Kaiser fee schedule · outpatient · +19 other terms	51	$258	$7.0k	$11.9k	171%	—	$12 – $53.0k
10	Ambetter facility · fee schedule · outpatient · +11 other terms	50	$212	$238	$46	19%	—	$30 – $269
11	WellCare fee schedule · outpatient · +16 other terms	49	$135	$251	$920	367%	—	$23 – $7.0k
12	MultiPlan fee schedule · inpatient · +15 other terms	41	$10.3k	$14.1k	$14.4k	102%	—	$1.7k – $61.7k
13	Devoted fee schedule · outpatient · +12 other terms	34	$125	$125	$8	6%	—	$116 – $139
14	Optum fee schedule · outpatient · +11 other terms	33	$125	$701	$1.5k	217%	—	$113 – $6.8k
15	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$201	$183	$61	33%	—	$75 – $316
16	Highmark facility · fee schedule · outpatient · +11 other terms	30	$83	$91	$76	83%	—	$23 – $401
17	Oscar facility · fee schedule · outpatient · +10 other terms	29	$104	$128	$81	63%	—	$29 – $234
18	Medica fee schedule · outpatient · +13 other terms	28	$469	$775	$920	119%	—	$18 – $2.2k
19	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
20	Regence professional · fee schedule · outpatient · +8 other terms	21	$21	$28	$27	98%	—	$21 – $153
21	Superior Healthplan facility · fee schedule · outpatient · +4 other terms	21	$131	$129	$3	2%	—	$125 – $131
22	Tricare facility · fee schedule · outpatient · +9 other terms	20	$127	$3.0k	$6.8k	228%	—	$53 – $31.8k
23	Clover facility · fee schedule · outpatient · +4 other terms	19	$134	$131	$8	6%	—	$117 – $139
24	Healthpartners fee schedule · outpatient · +7 other terms	19	$36	$39	$15	40%	—	$35 – $131
25	Medical Mutual facility · fee schedule · outpatient · +6 other terms	19	$111	$101	$71	70%	—	$35 – $468

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